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General NPI Number Information
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NPI Number | 1912932583
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Entity Type | Individual
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Provider Name | OTILIA DEJESUS MD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 12/08/2024
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Provider Practice Location Address
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Address Line | 265 BROOKVIEW CENTRE WAY STE 400
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City | KNOXVILLE
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State | TN
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Zip | 37919-4052
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Country | US
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Telephone | 800-342-2898
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Fax |
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Provider Business Mailing Address
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Address Line | 14526 PLUMOSA DR
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-2222
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Country | US
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Telephone | 407-375-9139
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME105497
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License Number State | FL
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